Exam 5 Thyroid

3.5-10.5

An average normal range for WBCs is between __-__ billion cells per microliter (mcL)

a, b, c, e

During initial therapy with levothyroxine (Synthroid), what are some of the most common reactions a nurse (Select all that apply) a. Elevated body temperature b. Weight loss c. Tachycardia d. Hypotension e. Irregular/scant menses

euthyroid

The goal of thyroid disorders is to restore the ____________ state (normal thyroid function)

50,000-450,000

The normal *platelet* count is __-__ per microliter

hemoglobin

The normal ____________ for males is 13.5-17.5 g/dL and for females is 12.0-15.5 g/dL (make sure value isn't in liters, because if it is, then numbers seem higher)

4.7-6.1

The normal range for RBCs is __-__ million cells/mcL

euthyroid

There is a black box warning on thyroid hormones where significant and serious complications may develop in ____________ people who take them (not used for weight loss)

radioactive iodine

____________ gradually shrinks the thyroid and is the most commonly used hyperthyroid treatment in the US. It is *permanent* and more reliable than antithyroid medications -thyroid cells absorb the radiation -90% of patients need only one dose before they're cured of their hyperthyroidism -reduced symptoms about a month after treatment -*administered orally* -*radioactive for 3 days, so use precautions* -metallic taste, nausea, swollen salivary glands -monitor for *hypothyroidism* -do not use if pregnant

propanolol

____________ is a beta adrenergic blocker and is used to control sympathetic symptoms during delayed response to thioamide drugs, iodine, surgery -*discontinue when euthyroid*

exophthalmos

____________ is seen in hyperthyroid patients and is the protrusion of the eyeball from the orbit

iodine

____________ is the essential element for the manufacturing of thyroxine and triiodothyronine

iodine deficiency

____________ is the most common cause of hypothyroidism worldwide

hypothyroidism

____________ is the most common type of thyroid dysfunction

vital signs

____________ would be the most important assessment in a patient taking levothyroxine because cardiac difficulties may occur early in treatment for hypothyroidism

thyroid storm

____________: *Assessment*: -sudden onset of CHF -change in mental status (delirium) -altered clotting -temperature, blood pressure, heart rate, respiratory INCREASE -*treat with propanolol* -depletes the body's supply of cortisol

hyperthyroidism

____________: -too much hormones released into circulation -Graves disease is a common cause -thyroid is overstimulated by TSH -*treatment*: surgical removal of thyroid or pituitary gland/radiation therapy -drug to block thyroxine (may then need thyroid replacement therapy) -amenorrhea, flushed/warm skin, tachycardia, palpitations, hyperactivity, nervousness, increase in blood volume, increase SBP, dysrhythmias, restlessness, anxiety, intolerance to heat, increased appetite, excessive perspiration

cretinism

____________: a congenital form of hypothyroidism that occurs when a child is born with a poorly functioning or absent thyroid gland -uncommon but may occur with a lack of iodine in the mother's diet -lack of potassium, sodium, and magnesium in mother's diet *will not cause* this

myxedema

____________: adult hypothyroidism (women)

leukopenia

____________: low WBC count

lithium

____________ acts synergistically with PTU to produce hypothyroidism (be sure to monitor blood values)

d

A 21 year old woman is taking LEVOTHYROXINE enough for hypothyroidism she has recently become sexually active and would like to take oral contraceptives which of the following aspects of patient teaching is most accurate a. A low dose oral contraceptive agent is permissible with levothyroxine b. Oral contraceptive agents increase the amount of thyroid hormone c. For protection from pregnancy it is necessary to use an oral contraceptive and alternate form of birth control d. Oral contraceptives agents result in diminished levothyroxine levels due to inactivation

b

A client informs the nurse that the client has been under treatment for weight loss management. The client indicates taking Antithyroid medication to increase weight loss. Which of the following would be included in client education: a. Antithyroid medication will increase weight loss; however, the client needs to take a calcium supplement as well. excessive or unnecessary b. Antithyroid medication may produce serious or life-threatening manifestations of toxicity. c. Antithyroid medication will increase weight loss; however, the client needs to take additional dietary supplements of iodine as well. d. Antithyroid medication will not contribute to weight loss; it only results in fat redistribution.

a

A female client reports nervousness and her heart still "racing" one week after starting antithyroid medication. How should the nurse respond to the client's report? a. It may take three to four weeks for the effects of this medication to be seen." b. "Have you counted your respiratory rate ? c. "I'll notify the primary care provider about increasing the dosage." d. "Increase the dosage of medication each day until relief of symptoms is achieved."

liver

A person on propylthiouracil should have routine ____________ testing -provide instructions to patient

d

A woman is taking PTU and develops a fever, and sore throat. What does the nurse suspect is wrong with the patient? a. She has developed a goiter b. She has elevated liver enzymes c. She has developed hypersensitivity reaction d. She has developed leukopenia/agranuocystosis

hypothyroidism

Causes of ____________ include: -diminished thyroid hormone -chronic Hashimoto's disease (autoimmune) -radiation -surgery -overtreatment of hyperthyroid

mental retardation

For congenital hypothyroidism (*cretinism*), drug therapy should begin within *6 weeks of birth and continued for life*, or ____________ may result -missing iodine in mother's diet during pregnancy/mother has hypothyroidism

hypothyroidism

In ____________ (or myxedema client), you will see: -decreased activity level -sensitivity to cold -weight gain -bradycardia -constipation -menstrual cycle changes -dry, brittle hair

levothyroxine

You should not take ____________ with medicines that have iodine/some shellfish

no

Is it okay to stop propylthiouracil abruptly?

hypothyroidism

Myxedema and cretinism (stunted growth) are signs of ____________

hypothyroidism

Nursing implementation for ____________ includes: -hormone replacement -pace activities with rest periods -restrict use of soap (dry brittle skin and hair) -extra clothing (cold) -small frequent feedings -increased fluid intake

anticoagulants (patient at risk for bleeding)

PTU may increase the effect of ____________

hypothyroidism

People with ____________ are especially likely to experience *respiratory depression* with opioid use and other sedating drugs

iodine

Potassium ____________ and sodium ____________ reverses thyroid hormone efficacy

iodine

Radioactive ____________ may be taken which shrinks the thyroid in hyperthyroidism

no (not with food either)

Should you take *levothyroixine* with other medications?

hematocrit

The ____________ is the proportion of RBCs to the fluid component, or plasma, in your blood *Male*: 38.8-50% *Female*: 34.9-44.5%

lifelong

Thyroid medication is ____________

hyperthyroidism

Thyroid storm and Graves disease are signs of ____________

propanolol

Thyroid storm is treated with ____________, which is a beta blocker (decreases blood pressure) (Also treated with PTU)

false

True or false? More patients experience hyperthyroidism than hypothyroidism

propylthiouracil (PTU)

What drug? ____________: -*class*: antithyroid medication -*side effects*: drowsiness, agranulocytosis, hepatitis -assess for *bruising, sore throat, malaise, SOB, change in weight* to assess for *leukopenia* -assess for *bone marrow suppression, liver function, anorexia, jaundice, light colored stool, dark urine, RUG pain* -*bloodwork is needed* if the therapeutic effect is not seen for weeks -watch for liver injury/failure within 6 months -*DO NOT STOP ABRUPTLY-rebound high thyroid state*

levothyroxine

What drug? ____________: -*class*: thyroid medication -*side effects*: arrhythmias -*AVOID* medicine with iodine and some shellfish -*black box warning*: not for weight loss, serious side effects when used in euthyroid patients -take with large glass of water

excrete

What happens to thyroid medications in a person with liver disease? A person with severe hypothyroidism cannot metabolize and ____________ the drugs

slow

What happens to thyroid medications in a person with liver disease? Hepatic metabolism in patients with hypothyroidism is ____________, so drug metabolism may be delayed

prolonged

What happens to thyroid medications in a person with liver disease? Many drugs given to these patients have a ____________ effect. It is therefore important to assess drug reaction in patients with hepatic dysfunction

propylthiouracil

What is the name of the medication that works AGAINST the thyroid? (antithyroid medication) -do not stop